"It's just another forced bill," said Christopher Pena, 24, a customer service worker. JASON HENRY, THE NEW YORK TIMES

CALIFORNIA’S HEALTH BENEFIT EXCHANGE FIRST IN NATION

California was the first state in the nation to create an exchange under the affordable care act. It will give individuals and small businesses the chance to purchase coverage in much the same way that state employees and retirees do now through the California Public Employment Retirement System, or CalPERS.

Insurers that want to sell to this pool of potentially several million Californians will submit their plans to the Exchange’s administrators. The plans will be required to offer at least a set of “essential” benefits approved by the state Legislature. Based on the coverage and the out-of-pocket costs, each plan will be rated either “platinum,” “gold,” “silver,” or “bronze.” The Exchange’s website will include a calculator to make it easy for consumers to compare plans.

-- By Dan Weintraub, for the Register

SPREADING THE WORD

Enroll America is a nonprofit group formed to get the word out to the uninsured, encourage them to get coverage and provide assistance.

The group has raised only about $6 million so far – but financial backers include some major players in the medical industry: insurers like Aetna and Blue Cross Blue Shield, associations representing both brand-name and generic drug manufacturers, hospitals and the Catholic Health Association. Insurance companies generally opposed the law before its passage in 2010 but now have a stake in its success.

Over the next two years, the group hopes to raise as much as $100 million for advertising, social media and other outreach efforts.

On its face, the low-key discussion around a conference table in Miami last month did not appear to have national implications. Eight men and women, including a diner owner, a chef and a real estate agent, answered questions about why they had no health insurance and what might persuade them to buy it.

But this focus group, along with nine others held around the country in November, was an important tool for advocates coming up with a campaign to educate Americans about the new health care law. The participants were among millions of uninsured people who stand to benefit from the law. With incomes below 400 percent of the poverty level, or $92,200 for a family of four this year, the focus group members will qualify for federal subsidies to help cover the cost of private insurance starting in 2014.

LACK OF UNDERSTANDING

The sessions confirmed a daunting reality: Many of those the law is supposed to help have no idea what it could do for them. In the Miami focus group, a few participants knew only that they could face a fine if they did not buy coverage.

"It's another forced bill," said Christopher Pena, 24, who works in customer service.

There lies the challenge for Enroll America. With the election over and the law almost certain to survive, the group is honing its fundraising and testing strategies for persuading people to sign up for health insurance – a process that will begin in less than a year.

Starting next October, people will be able to shop for coverage, or find out if they are eligible for Medicaid, through online markets known as insurance exchanges.

"Our job is to convey to them that there is help coming that they didn't know about," said Rachel Klein, Enroll America's executive director.

Although the campaign will be national, the group will devote more resources to some states than to others. About half of the nation's uninsured population lives in six states: California, Florida, Georgia, Illinois, New York and Texas. Of those, states whose leaders remain opposed to the health care law, like Texas, will probably get the most attention, Pollack said.

OVERCOMING SKEPTICISM

In addition to holding focus groups in Miami, Philadelphia, San Antonio and Columbus, Ohio, Enroll America commissioned a nationwide survey to help hone its message. The survey, conducted in September and October by Lake Research Partners, a Democratic polling group, found that the vast majority of uninsured people are unaware of the new coverage options provided by the law.

They are also skeptical. Many who participated in the focus groups or survey reported bad experiences trying to get health insurance, and doubted that the law would provide coverage that was both affordable and comprehensive.

LIKING COVERAGE, NOT COSTS

One message in particular resonated with the survey respondents: that under the new law, all insurance plans would have to cover doctor visits, hospitalizations, maternity care, emergency room care and prescriptions. They also liked the statements, "If you have a pre-existing condition, insurance plans cannot deny you coverage," and "You might be able to get financial help to pay for a health insurance plan."

But the survey found that even with federal subsidies, many uninsured people may balk at the cost of coverage. Only about a third of respondents leaned toward thinking monthly premiums of $210 for a single person earning $30,000 a year, for example, were affordable.

Those amounts became more acceptable when respondents were told it would "protect you from thousands of dollars of medical debt if you got sick" or "cover all of the basic care you need."

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